ADHD in Adults
Whilst a primary diagnosis of ADHD is not made in adults, a retrospective diagnosis based on appropriate history may be made. The persistence of ADHD into adulthood is well recognised and accepted in specialist clinical practice (see e.g. Asherson et al, 2006). A childhood diagnosis of ADHD has long term implications with more than 70% of children continuing to fulfil diagnostic criteria in adolescence, and up to 65% of adolescents still presenting with the disorder as adults (Jadad et al. 1999). It has been suggested that 0.5-1 % of the young adult population have symptoms associated with ADHD and would benefit from access to psychiatric services (Toone and Van der Linden, 1997). Despite the increasing literature on ADHD in adults (e.g. Rosca-Rebaudengo et al, 2000), the diagnosis in adulthood is still however somewhat controversial (Zwi and York, 2004).
Adults with untreated ADHD symptoms utilise a high degree of primary care resources, often attract poor employment records, have more motor vehicle accidents and present with high degree of co-morbid psychiatric disorders and substance misuse.
Stringent diagnosis is key to determining effective treatment and stimulant medications remain the most widely used treatment for adult ADHD. A number of small trials of methylphenidate in adults with ADHD have shown that between 25% and 60% of patients show a clinical benefit. However, none of the available stimulant preparations are licensed for adult use. Clinicians should also note that the American Academy of Child and Adolescent Psychiatry practice parameters for the assessment and treatment of ADHD (1997) relate to adults as well as children and adolescents as do the practice parameters for the use of stimulant medications (Greenhill et al, 2002).
Atomoxetine is the first non stimulant to be licensed for ADHD in the UK and is licensed for the treatment of ADHD in children of 6 years and older and adolescents. It is also licensed for adults who were diagnosed with ADHD as children or adolescents. It has been shown to be comparable to methylphenidate on core symptom efficacy (Heilengenstein et al, 2000).
Additional information relevant to UK practitioners is now available from the National Institute for Health and Clinical Excellence who have produced guidance for the assessment and management of ADHD (see www.nice.org.uk/CG072).
There is a CPD module on Adult ADHD available upon subscription from the Royal College of Psychiatrists
